SURGEON-PERFORMED ULTRASOUND FOR THE ASSESSMENT OF TRUNCAL INJURIES -LESSONS LEARNED FROM 1540 PATIENTS

Objective To determine the accuracy of the Focused Assessment for the Sonographic examination of the Trauma patient (FAST) when performed by trauma team members during a 3-year period, and to determine the clin ical conditions in which the FAST is most accurate in the assessment o f injured patients. Summary Background Data The FAST is a rapid test t hat sequentially surveys the pericardial region for hemopericardium an d then the right and left upper quadrants and pelvis for hemoperitoneu m in patients with potential truncal injuries. The clinical conditions in which the FAST is most accurate in the assessment of injured patie nts have yet to be determined. Methods FAST examinations were performe d on patients with precordial or transthoracic wounds or blunt abdomin al trauma. Patients with a positive ultrasound (US) examination for he mopericardium underwent immediate surgery, whereas those with a positi ve US for hemoperitoneum underwent a computed tomography scan (if they were hemodynamically stable) or immediate celiotomy (if they were hem odynamically unstable - blood pressure less than or equal to 90 mmHg). Results FAST examinations were performed in 1540 patients (1227 with blunt injuries, 313 with penetrating injuries). There were 1440 true-n egative results, 80 true-positive results, IB false-negative results, and 4 false-positive results; the sensitivity was 83.3%, the specifici ty 99.7%, US was most sensitive and specific for the evaluation of pat ients with precordial or transthoracic wounds (sensitivity 100%, speci ficity 99.3%) and hypotensive patients with blunt abdominal trauma (se nsitivity 100%, specificity 100%). Conclusions US should be the initia l diagnostic modality for the evaluation of patients with precordial w ounds and blunt truncal injuries because ii: is rapid and accurate. Be cause of the high sensitivity and specificity of US in the evaluation of patients with precordial wounds and hypotensive patients with blunt torso trauma, immediate surgical intervention is justified when those patients have a positive US examination.